The Elephant in the Jail: Tackling the Challenge of Substance Misuse (Podcast 144)

In this episode, Lorry talks with Dawn Noggle, PhD, CCHP, Grant Phillips, MD, CCHP, and Rebecca Quince, MBA, CCHP, from Maricopa County Correctional Health Services about their work in reducing substance misuse among their patient population. Dr. Noggle is Mental Health Director, Dr. Phillips is Medical Director and Rebecca Quince is Business Integration and Technology Manager for the service.

The Elephant in the Jail – A Big Issue!

Substance misuse is definitely an elephant of an issue for our patient population, yet so many correctional organizations struggle to deal with the challenge. Our patients are dependent on or addicted to a variety of drugs as well as alcohol. Most settings provide some type of support for withdrawal, and that’s a start. However, recent research indicates that other interventions such as methadone maintenance treatment (MMT) can decrease disciplinary issues while incarcerated and possibly reduce recidivism. Research findings like these can help gain support from custody peers when beginning to implement substance misuse programs.

Start at the Beginning – SBIRT

Healthcare services at Maricopa County have implemented several substance misuse programs such as MMT and nasal spray naloxone provided at release. However, the start of treatment is always at entry into the facility, where they use the SAMHSA SBIRT program. The acronym stands for Screening, Brief Intervention, and Referral to Treatment. Here are two examples of how it works at Maricopa.

Tips to Get Started

Healthcare leaders at Maricopa County will be the first to identify that developing and consistently implementing substance misuse programs is slow going. There are so many moving parts and so many disciplines that need to be part of the process. They have been working on the program for at least 5 years and are now seeing positive results. Here are some thoughts on what helps keep things working in their setting.

Give everyone in the facility the ‘why’ of the program. This provides a sense of purpose, meaning, and understanding.

Be sure that everyone is represented at the table when developing, implementing, and troubleshooting a new program.

Frequently re-affirm the mission of the project. It is easy to get lost in the weeds.

Standardize the workflow of new systems through data collection and automation, where possible.

Seek out ways to use data to drive decision-making. Basic tools like spreadsheets and written records can be used in the absence of robust electronic documentation systems.

How about you? How do you deal with substance misuse in your correctional setting? Share your thoughts in the comments section of this post.

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